The Truth Behind Ice or Compression for Inflammation

interesting blog post by Kelly Starrett, DPT. Kelly does a great job of making advanced rehabilitation techniques accessible to the masses. I am really impressed by how proliferative his blog is. You should check it out.

Medicine advances by tossing out previously held ideas in favor of newer ideas that have a greater weight of scientific evidence. Sometimes a “sacred cow” develops, and idea about a certain treatment that has more cultural/authoritative support than scientific support. I love killing sacred cows, and Dr. Starrett takes on a big one here. But I think may take his recommendation too far.

Below are excerpts from the Kelly’s post entitled, People. We’ve Got to Stop Icing. We Were Wrong, Sooo Wrong.

We should not ice. For the last year, I’ve advocated for no icing with every athlete with whom I’ve helped either post-surgery or post-injury. The outcomes have been nothing short of stunning.

Observations like this are pragmatic, and should be balanced with the weight of scientific evidence and the goals of the patient/client. Yet observations alone do not mean much.

My problem with NOT icing, I told myself was that I didn’t have other good tools on hand to minimize the pain of swelling…

Once again, very pragmatic and patient focused. No sense in throwing out a treatment if you have no option with which to replace it. Unless the treatment makes one worse, in which case doing nothing is a great option.

Don’t get me wrong, if you need to make something numb, ice is great….if the short-term goal is pain control and the prevention of the body’s normal cellular and vascular response to injury.

I agree. Both research and observation support that brief application of ice is helpful for pain and the body’s inflammatory response. Next time you slam your thumb in the door would you rather reach for the ice, or dunk it in warm water? So, there is an appropriate place for ice, especially in the context of pain control and reduction of an acute inflammatory response.

Let me quote Dr. Nick DiNubile, Editor in Chief of The Physician And Sports Medicine Journal “Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?”

The inflammatory response is a tissue healing response. At the basic cellular level, it breaks down and rebuilds injured tissue. A beautiful thing. An inflammatory response that is exuberant can result in further tissue damage by compressing other tissues (affecting nerve and blood supply), and chemically damaging adjacent nerves. On the other hand, suppressing the inflammatory response via oral or injected anti-inflammatory medications can abort appropriate tissue healing. Obviously, this varies significantly on a case-by-case basis, so no one can make a blanket statement regarding what treatment would be best.

This report basically reviewed the literature and found that not many researchers have studied the effect of ice on humans. One human study suggested that it “improves return to participation.” 4 of 4 animal studies demonstrated reduced swelling, yet the paper concludes that there is insufficient evidence. Conclusions like this are very common in the biomedical literature, especially in regards to physical medicine. Researchers are very conservative in their conclusions. The paper concludes that there is not a meaningful amount of research studies that would conclusively support use of ice. No surprise.

Look, I know you have iced your body about a billion times.

Really? If that is the case, I agree, you should stop using ice. If your body is having an uncontrolled inflammatory response either your training activity is not mechanically efficient (you are hurting yourself) or your inflammatory state is out of balance (could be your diet).

Our goal needs to be to improve adaptation by improving circulation, clearing congestion, and facilitating healing. Pretty much everyone I know has stopped taking NSAIDS for the same reasoning that we should stop icing.

Right on. Chronic NSAID use for athletic induced pain is foolish, and so is chronic ice application. If you feel the need to ice the same area on a repeated basis, you should probably ask why this is an issue. Do not ignore the check engine light.

The bottom line is that ice application is a wonderful tool. It is not the only tool. If you are unclear about why should use a certain tool, how to use it, or what you are using it for, do not be surprised if it is not effective.

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